An Evaluation of Physiotherapist
Independent Prescribing in Queensland
Mark Cruickshank
Physiotherapy – RBWH
2019 National Allied Health Conference
Challenges
demographic changes and the demand for health services[1]
2015 - 4.5 people aged 15-64 for every person 65 or older 2055 - 2.7 people aged 15-64 for every person 65 or older older population are higher users of the health system [2]
coordinated management of chronic conditions 75-84 age group - 72% have at least one chronic musculoskeletal condition, primarily
managed conservatively (e.g. physical therapies and medications) [3]
increasing community demands for responsiveness 1 in 5 people currently report waiting longer than acceptable to see their GP (worse in
remote areas which disproportionately disadvantages our indigenous population) [4]
Av age of GPs is 54 years and over 50% intend to retire in the next 10 years –traditional prescriber shortage [5]
Background
Challenges increasing health care expenditure
in the last 10 years total health expenditure has increased in real terms by 50%, population increase by only 17% over the same period. [6]
Solutions [7]
new models of care that enhance productivity adjustments to skill mix to allow the medical workforce to focus on tasks only
they can undertake ensuring other health professionals work to maximise their scope of practice
As an example, non-medical prescribing is a method of increasing the number of prescribers to meet community requirements for timely access to medicines while reducing the demand on the traditional prescriber workforce [8] [9]
Background
Trial Overview
As part of the overall model of care in Emergency Departments,
prescribing by primary contact physiotherapists aims to safely
improve the efficiency and effectiveness of the management of
MSK conditions, by enabling prescribing within the scope of
practice for physiotherapy
Patients have improved timely access to appropriate care and analgesia
Medical staff are released to manage more complex presentations
within the ED
Multicentre descriptive trial
2500 patients over 18 – 24
months
TPCH (2)
GCUH/Robina (1) Cairns (1)
QEII (2)
RBWH (2)
Getting Started
Health Professionals Prescribing Pathway [4]
Getting Started
Complete education
& training
Obtain recognition
from National
Board of
competence to
prescribe
Ensure
authorisation to
prescribe
Prescribe medicines
within scope of
practice
Maintain & enhance
competence to
prescribe
Prescribing
Training (QUT)• 150 hr coursework &
120 hr LIP
• Clinical
Therapeutics
• QUM & safe
prescribing
Credentialing• No Board
endorsement
• HHS credentialing
applications
• New service
application
• Individual extended
scope applications
Authorisation to
Prescribe• Approval to
prescribe under
S18 of the Health
Drugs & Poisons
Regulation as part
of research trial
Protocol, MOC &
Formulary• Protocol approved
by Ethics
• Formulary approved
by local MAC
• Existing MOC
Audit process• Local Gov. group
• NIMC audits
• Patient experience
and satisfaction
• Discharge script
audits
• Clinical incident
monitoring
Physiotherapy Defined Scope of Practice Trial – Prescribing
Governance
Local Drug Protocol Development & Endorsement through local Governance
Trial Local Governance Group Established
Site Specific Applications
Protocol Development and Ethics
Section 18 application to Medicines Regulation Quality Unit
HHS CE approval for Section 18 (HDPR) application
Prescribing Training (QUT) –coursework 150hrs & 120hrs LIP
Endorsement of Approved course of study by CHO
Trial commencement -Prescribing starts
Local Credentialing Committee approval for Extended Scope
Practice
*First participant recruited March 2017
• Prescribing Incidents
• Accuracy of PrescribingSafety
• Completeness of prescribing
• Technical efficiencyEfficiency
• Patient Experience
• Patient SatisfactionResponsiveness
Adapted from: Hale, A.R., et al., An evaluation framework for non-medical prescribing research. Aust Health Rev, 2012. 36(2): p. 224-8 & The National Health Information and Performance Principal Committee. The Australian Health Performance Framework. 2017.
Evaluation
Results to date - Safety
Safety – Adverse Events from PTHY prescribing error = 0
0
200
400
600
800
1000
1200
1400
1600
1800
CairnsHospital
Gold CoastUni Hosp
QEII RBWH TPCH Total
456
123
315
451
154
1499
468
159
387
572
170
1756
Participants & Written Orders
Participants
All Orders
Results to date
50
430
928
1208
0 200 400 600 800 1000 1200 1400
NUMBER OF PARTICIPANTS
TYPE OF PRESCRIBING
ACTIVITY
Frequency of Different Prescribing Activities
OTC Advice given
NIMC order/s
Medicines Optimised
EPP D/C Script issued
Results to date – Safety & Efficiency
Results to date – Responsiveness
Responsiveness – Patient Experience (n=871/879)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree
Confidence in physiotherapist prescribing medications safely
98%
Results to date – Responsiveness
Responsiveness – Patient Experience (n=869/879)
98%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Strongly Agree Agree Neither Agree nor Disagree Strongly Disagree
Trust physiotherapist's ability to prescribe right medications
Results to date – Responsiveness
Responsiveness – Patient Satisfaction (n=867/879)
0%
10%
20%
30%
40%
50%
60%
70%
80%
Very satisfied Satisfied Neither satisfied nordissatisfied
Dissatisfied Very dissatisfied
Satisfaction with Physiotherapist managing medication needs
92%
Summary and Future Directions
Preliminary trial data suggests autonomous prescribing by physiotherapists:
achieved safely within physiotherapy scope of practice
done with an acceptable level of accuracy, completeness and efficiency when compared to other prescribers
responsive to the needs of consumers with very high levels of confidence, trust and satisfaction
Future directions
investigate the domain of appropriateness of physiotherapy prescribing
develop new prescribers and expand to additional sites
achieve sustainable authorisation for prescribers outside of research trial framework
Contact Details
For further information, contact:
Allied Health Professions Office of Queensland
Royal Brisbane and Women's Hospital Foundation
Acknowledgements
References
1. Commonwealth of Australia. 2015 Intergenerational Report Australia in 2055. 2015.
2. Australian Institute of Health and Welfare. Australia’s Health 2016. Australia’s health series no. 15. In. Vol Cat. no. AUS 199. Canberra: AIHW2016.
3. Australian institute of Health and Welfare. Musculoskeletal conditions and comorbidity in Australia no. 25. Cat. no, PHE 241. In. Canberra: AIHW2019.
4. Australian Bureau of Statistics. Patient Expereinces in Australia: summary of findings, 2016-17 cat. no.4839.0. In: ABS, ed. Canberra: ABS2017.
5. Commonwealth of Australia - Department of Health. National Health Workforce Data Set General practice - 2016 Factsheet. In:2017.
6. Australian Institute of Health and Welfare. Health expenditure Australia 2016–17. In. Canberra: AIHW; 2018.
7. Commonwealth of Australia. Health Workforce Australia 2014: Australia’s Future Health Workforce - Doctors. Canberra2014.
8. Morris, J.H. and K. Grimmer, Non-medical prescribing by physiotherapists: issues reported in the current evidence. Man Ther, 2014. 19(1): p. 82-6.
9. Cardiff, L., ASPRINH Project Prescribing Assessment Toolkit. 2017.
10.Health Workforce Australia, Health Professionals Prescribing Pathway (HPPP) Project -Final Report. 2013.
11.Allied Health Professions' Office of Queensland. A framework for allied health professional prescribing trials within Queensland Health. In: Department of Health. Queensland Govenment; December 2014.